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Carotid artery stenting via a femoral bypass graft: technical note
Kentaro Hayashi1, Naoki Kitagawa, Hideaki Takai
1Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan. kenkuni@net.nagasaki-u.ac.jp
Insights
This study presents a novel endovascular approach for treating severe carotid artery stenosis using a femoral bypass graft. This method offers a viable solution when traditional access routes are compromised.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Procedures
Background:
- Cervical internal carotid artery stenosis poses significant stroke risk.
- Standard transradial access can be challenging due to complex arterial anatomy.
- Previous bypass grafts may present unique access opportunities.
Observation:
- A 70-year-old patient with extensive vascular disease required revascularization for severe right internal carotid artery stenosis.
- Transradial access was not feasible due to left subclavian artery occlusion and a calcified aortic arch.
- Bilateral femoral arteries had been replaced with bypass grafts due to atherosclerosis obliterans.
Findings:
- Access was successfully obtained via an exposed left common femoral-popliteal bypass graft.
- Endoluminal stent placement for the internal carotid artery stenosis was achieved through this alternative route.
- The procedure was completed successfully with the guiding sheath introduced through the bypass graft.
Implications:
- This novel femoral bypass graft access technique should be considered for complex endovascular procedures.
- It provides a crucial alternative when standard carotid artery access is limited or impossible.
- This approach expands the possibilities for treating challenging cerebrovascular disease.
Background:
We described a case of endoluminal stent placement for a cervical internal carotid artery stenosis in which access was obtained via the femoral bypass graft.
Case Description:
A 70-year-old man with known disease of the carotid, peripheral, and coronary arteries as well as congestive heart failure presented for endoluminal revascularization of a severe right internal carotid artery stenosis. Transradial access was complicated by the left subclavian artery occlusion and hypercalcified aortic arch. Bilateral femoral artery was replaced with bypass graft because of atherosclerosis obliterans. An alternative approach was attempted via the exposed left femoral bypass graft. The left inguinal region was incised, and the left common femoral-popliteal bypass graft was exposed. After placement of a purse string suture at the puncture site, the guiding sheath was introduced into the graft and positioned into the right common carotid artery. Stenting was successfully performed, and the suture was tied after withdrawing the sheath.
Conclusions:
This novel approach should be considered for endovascular procedures for which access to the carotid artery is limited.